The Hands-on Guide to Surgical Training

Matthew Stephenson

• Publisher: Wiley-Blackwell
• Year: 2011
• ISBN:
  9781118268704
• Edition: 1
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

Thinking about a surgical career? About to start surgical training? Do you know what to expect and how to thrive?

The Hands-on Guide to Surgical Training is the ultimate, practical guide for medical students and junior doctors thinking about taking the plunge into surgery, and also for surgical trainees already in training. It's full of invaluable, practical information and career guidance to ensure you get the most out of your surgical career.

It offers general guidance and advice on surgical training, together with detailed information on each of the nine surgical subspecialties, each written by seniors and consultants, as you make both clinical and career-based choices.

Undoubtedly one of the most comprehensive resources for surgical trainees available, The Hands-on Guide to Surgical Training will be essential reading throughout your training and surgical career.

Take the stress out of surgical training with The Hands-on Guide!

Appendix 1
PREOPERATIVE ASSESSMENT

Few things are as embarrassing as being responsible for the cancellation of a patient due to inadequate preoperative preparation, or worse, an avoidable adverse perioperative outcome. We all dread the anaesthetist turning up to see the pre-ops and finding some failure in preoperative assessment meaning that the patient’s surgery is cancelled or delayed. Someone forgot to request a sickle cell test. No one ordered cross-matched blood. The INR of 5.0 went unnoticed.

Who’s responsible for all this? It’s usually the most junior person, the FY1, who gets blamed. But if you’re reading this smugly as a senior, sorry, you also have your responsibility to oversee the process and check up on the results. Everyone is responsible, even the consultant, but try telling him that. And few things are worse than having to apologise to an anaesthetist.

Clearly there are going to be some differences in the preoperative preparation and assessment of elective cases versus emergency cases, mainly in terms of the amount of time you’ll have to fully investigate a patient, but there’s not much excuse for failing to fully assess elective patients.

Pre-assessing Elective Patients

Take a full history and thoroughly examine the patient. Concentrate first on the pathology they’ve come to have operated on, e.g. how long have they had their inguinal hernia? What problems is it causing them, etc? Is it possible that whoever listed that person for surgery actually got the diagnosis wrong, or that the surgery is no longer needed or desired? Next concentrate on the patient’s co-morbidities and medication list. Ask specifically about the following.

1 Cardiorespiratory disease – Angina? MIs? COPD? Breathlessness? Cough? etc. This is probably the most crucial aspect of preoperative assessment from the anaesthetic point of view, as surgery places a strain on the physiological reserves of these organs.

2 Other co-morbidities, e.g. THREADS (TB, hypertension, rheumatic fever, epilepsy, asthma, diabetes, stroke) or renal disease.

3 What medications are they on, including doses and frequency? Which need to be stopped?

4 Do they smoke? If so it must be strongly recommended that they quit a minimum of 24 hours before anasthetic.

5 Do they drink alcohol and how much? Will they need detoxifying medication on admission?

6 How are they going to manage after the surgery? Will they have a partner at home to look after them? Will they manage the stairs?

Thorou...

Table of contents

• Cover
• Title page
• Copyright page
• Preface
• Introduction
• Contributors
• So you want to be a surgeon?
• Abbreviations
• Clinical
• Non-clinical
• Appendix 1 PREOPERATIVE ASSESSMENT
• Appendix 2 CONSENT
• Appendix 3 LOCAL ANAESTHETICS
• Index